Dopamine D2 antagonist antiemetic / prokinetic Pregnancy: A large amount of data on pregnant women (more than 1000 exposed outcomes) indicates neither malformative toxicity nor foetotoxicity; metoclopramide can be used during pregnancy if clinically needed. Avoid at the end of pregnancy (extrapyramidal syndrome in the newborn cannot be excluded); if used, undertake neonatal monitoring. Not recommended during breastfeeding. Fertility: no data available.

Metoclopramide hydrochloride

Brand names: Maxolon

Metoclopramide hydrochloride is a dopamine antagonist with prokinetic and antiemetic properties, used for nausea and vomiting and to promote gastric emptying.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg single dose (all indications, adult patients)

Route: Oral; also suitable for administration via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes

Frequency: Repeated up to three times daily; a minimal interval of 6 hours between two administrations is to be respected, even in case of vomiting or rejection of the dose

Max: 30 mg per day or 0.5 mg/kg body weight per day

eMC §4.2: maximum recommended treatment duration is 5 days. Elderly: a dose reduction should be considered, based on renal and hepatic function and overall frailty. Hepatic impairment: in severe hepatic impairment the dose should be reduced by 50%. eMC §4.4 states treatment should not exceed 3 months because of the risk of tardive dyskinesia; patients treated for delayed gastric emptying should be reviewed at an early stage for response; care is needed in patients with a history of atopy (including asthma) or porphyria.

Paediatric dose

Route: Oral

Frequency: Repeated up to three times daily; minimum 6-hour interval between administrations

Max: 0.5 mg/kg body weight in 24 hours

Licensed paediatric indication in this SPC is prevention of delayed chemotherapy induced nausea and vomiting (CINV) in patients aged 1-18 years only. eMC §4.2 gives a range, not a single per-kg value: 0.1 to 0.15 mg/kg body weight, repeated up to three times daily by the oral route. Dosing table: 1-3 years (10-14 kg) 1 mg (1 ml); 3-5 years (15-19 kg) 2 mg (2 ml); 5-9 years (20-29 kg) 2.5 mg (2.5 ml); 9-18 years (30-60 kg) 5 mg (5 ml); 15-18 years over 60 kg 10 mg (10 ml) — all up to 3 times daily. Maximum treatment duration 5 days for delayed CINV. Contraindicated in children aged less than 1 year (§4.3). Verify all paediatric dosing against a children's formulary before prescribing.

Dose adjustments

Renal

End stage renal disease (creatinine clearance ≤15 ml/min): reduce the daily dose by 75%. Moderate to severe renal impairment (creatinine clearance 15-60 ml/min): reduce the dose by 50%.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to metoclopramide hydrochloride or any of the excipients; patients hypersensitive to procaine and procainamide may show cross-sensitivity
First three to four days following operations such as pyloroplasty or gut anastomosis, as vigorous muscular contractions may not help healing
Gastrointestinal haemorrhage, mechanical obstruction or gastro-intestinal perforation for which stimulation of gastrointestinal motility constitutes a risk
Confirmed or suspected phaeochromocytoma, due to the risk of severe hypertension episodes
History of neuroleptic or metoclopramide-induced tardive dyskinesia
Epilepsy (increased crises frequency and intensity)
Parkinson's disease
Combination with levodopa or dopaminergic agonists
Known history of methaemoglobinaemia with metoclopramide, or of NADH cytochrome-b5 deficiency
Use in children less than 1 year of age due to an increased risk of extrapyramidal disorders

Side effects

Somnolence (very common)
Extrapyramidal disorders, parkinsonism, akathisia (common) — particularly in children and young adults and/or when the recommended dose is exceeded
Depression and restlessness (common)
Hypotension, particularly with intravenous formulation (common)
Diarrhoea and asthenia (common)
Not known: tardive dyskinesia (may be persistent), neuroleptic malignant syndrome, cardiac arrest/asystole and QT prolongation after injectable use, methaemoglobinaemia

Interactions

Levodopa or dopaminergic agonists — combination is contraindicated (eMC §4.3)
Other centrally-acting drugs — special care required; increased risk of extrapyramidal effects (eMC §4.4)
Neuroleptics — neuroleptic malignant syndrome reported with metoclopramide in combination with neuroleptics (eMC §4.4)
High doses of sulfur-releasing medicinal products — sulfhaemoglobinaemia reported with concomitant administration (eMC §4.8)
US labelling: antipsychotics — potential additive tardive dyskinesia, extrapyramidal symptoms and neuroleptic malignant syndrome; avoid concomitant use
US labelling: strong CYP2D6 inhibitors (e.g. quinidine, bupropion, fluoxetine, paroxetine) increase metoclopramide concentrations — dosage reduction recommended
US labelling: CNS depressants — increased risk of CNS depression, avoid concomitant use; MAO inhibitors — increased risk of hypertension, avoid concomitant use

Clinical monograph

How it works

It blocks central and peripheral dopamine D2 receptors, suppressing the chemoreceptor trigger zone while enhancing gastric and upper gastrointestinal motility, with additional 5-HT3 antagonism and weak 5-HT4 agonism at higher doses.

Prescribing in practice

Because of the risk of extrapyramidal and other neurological effects, MHRA advice restricts metoclopramide to short-term use and to standard rather than high doses, with particular caution and dose limitation in children and young adults.
It is contraindicated in gastrointestinal obstruction, perforation or haemorrhage, in phaeochromocytoma, and shortly after gastrointestinal surgery, and dose reduction is needed in renal or hepatic impairment.
Acute dystonic reactions can occur early in treatment, and concurrent use with other dopamine antagonists increases the risk of extrapyramidal effects.

Monitoring

Monitor for extrapyramidal symptoms, tardive dyskinesia with prolonged use, and signs of neuroleptic malignant syndrome, reviewing the need for continued treatment regularly.

Counselling the patient

Use this medicine only for the short course your prescriber advises.
Stop and seek urgent help if you develop abnormal movements, muscle spasms of the face or neck, or restlessness.

Evidence & guidelines

Following a European review, the MHRA restricted metoclopramide to short-term use at standard doses to reduce the risk of neurological adverse effects.

Reference: MHRA Drug Safety Update 2014; NICE CG150; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways